Nurse turnover is high, but is that a problem?

"One of the biggest problems we face in trying to assess the impact of nurse turnover on our health care system as a whole is that there's not a single, agreed-upon definition of turnover," says Christine Kovner. (Credit: Airman Magazine/Flickr)

About 17.5 percent of newly licensed registered nurses leave their first job within a year—and 33.5 percent leave within two years.

Registered nurse turnover is an important and widely used measure in analyzing the health care workforce. It’s used to project the job market for nurses (based on availability of jobs) and can also be considered an indicator of whether a health care organization has a good working environment.

But there is no universal definition of what turnover means.

For a study, published in the journal Policy, Politics, & Nursing Practices, researchers used synthesized existing turnover data and reported turnover data from a nationally representative sample of RNs conducted by the RN Work Project. It is the only longitudinal study of RNs in the United States. The data comes from surveys of three cohorts of newly licensed RNs conducted since 2006.

What is turnover?

Registered nurses leaving their jobs is costly for hospitals and also affects quality of care.

Organizational costs associated with RN turnover can be as much as $6.4 million for a large acute care hospital. Studies have associated turnover among health providers with an increase in the use of physical restraints, pressure ulcers, and patient falls.

“One of the biggest problems we face in trying to assess the impact of nurse turnover on our health care system as a whole is that there’s not a single, agreed-upon definition of turnover,” says Christine Kovner, professor of nursing at New York University.

“In order to make comparisons across organizations and geographical areas, researchers, policymakers, and others need valid and reliable data based on consistent definitions of turnover. It makes sense to look at RNs across multiple organizations, as we did, rather than in a single organization or type of organization to get an accurate picture of RN turnover.”

Researchers say there are different kinds of turnover, and that in some cases, RN turnover can actually be helpful. In cases of functional turnover, a poorly functioning employee leaves, as opposed to dysfunctional turnover, when well-performing employees leave.

Organizations should pay attention to the kind of turnover occurring, the researchers say, and point that the data indicate that when most RNs leave a job, they go to another health care job.

Standard definition

“Developing a standard definition of turnover would go a long way in helping identify the reasons for RN turnover and whether managers should be concerned about their institutions’ turnover rates,” says Carol Brewer, professor of nursing at University at Buffalo.

“A high rate of turnover at a hospital, if it’s voluntary, could be problematic, but if it’s involuntary or if nurses are moving within the hospital to another unit or position, that tells a very different story.”

The RN Work Project’s data include all organizational turnover (voluntary and involuntary), but don’t include position turnover if the RN stayed at the same health care organization.

The RN Work Project is a 10-year study of NLRNs that began in 2006. It is the only multi-state, longitudinal study of new nurses’ turnover rates, intentions and attitudes—including intent, satisfaction, organizational commitment, and preferences about work. The study draws on data from nurses in 34 states, covering 51 metropolitan areas and nine rural areas.